Brazosport Professional Eye Clinic Inc
NPI 1073607370ActiveOrganization· Optometrist· Lake Jackson, TX
Optometrist in Lake Jackson, Texas, registered in NPPES in October 2006. The authorized official on file is Mark Allen Provenzano, OD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1073607370 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 3, 2006 |
| Last updated in NPPES | Dec 11, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X | 3979TG | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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